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It’s been a scary few weeks here on the homefront.  Two weeks ago, I went for my routine annual physical.  It went fine during the physical. Exercise more, try to lose ten pounds by next year, all the standard stuff.  

The Bloodwork

The doctor also ordered bloodwork labs, which he does every year.  Well, everything came back normal except for one big outlier – my platelets.  They were pretty low.

Platelets should be in the 140-400 range.  Mine were 34.  I’ve never had platelet issues before.  (For reference, my platelets were 297 during my 2017 physical, and 300 during my 2016 physical. In all prior years, they’ve hovered around that same amount plus or minus 30 or so).   Apparently some consider it a medical emergency if platelets drop below 20, as it can cause spontaneous bleeding or hemorrhaging within the body. So, with mine being at 34, I was pretty concerned.

 

Dr. S (my primary care physician) called and asked me if I had had any recent viral infections or had started any new medications recently.  I told him the only infection I had had recently was a bacterial one. I had a UTI about a month earlier, and had been prescribed a 5-day-course of the antibiotic Macrobid.  

Dr. S said okay, sometimes antibiotics can affect platelet counts, so come back in to have the bloodwork redone in ten days to see if my platelet count improves.  I said okay.

Commence immediate Googling of “low platelet counts.”  Commence immediate panic.

I don’t think I could use another search phrase to make the term “Leukemia” appear in Google search results any more than “low platelets.”  

And, I learn that low platelet counts has a more formal name.  Thrombocytopenia.

The Waiting Game

The next ten days were torturous.  At a certain point I just stopped Googling things because there were too many unknowns:  

• The Macrobid I had taken for my UTI, lists thrombocytopenia as a potential side effect.  
• I had probably also been taking my evening wine enjoyment a bit too frequently recently, and I read that alcohol can inhibit platelet formation.  
• As an added variable, my gynecologist had me switch from my LONG term birth control method of Nuvaring to a progesterone-only method (the mini-pill) back in January.  Although based on my entirely non-scientific Google searching, it doesn’t appear that birth control affects platelet counts. However, there are some anecdotal cases of “hormone changes” triggering faulty immune responses to platelets.  

Upon learning these things (through my random Google searching), I stopped all alcohol imbibing, stopped drinking soda, and cut out all caffeine as well.  I decided to eat super healthily and hoped that it would have an improved effect on my platelet count.

I was really hoping that it was perhaps just a combination of the Macrobid and recent wine drinking that kept my platelets low.  And hoped that that, as time passed, my platelet count would improve.

Torturing Myself with Speculation

But, in the back of my head, I knew that the Macrobid/Wine combination probably wasn’t the reason.  Because, the more I thought about it, the more I remembered the appearance of unexplained bruises on my thigh and knee that I was pretty certain pre-dated my Macrobid round.  They were completely painless bruises which I thought was unusual, but not enough to raise any red flags.

Then I thought back to a few months earlier and doing Yoga.  During certain poses, like downward dog and cat/cow, my nose would start to drip this orange-tinged runny mucus.  It had never happened before. I convinced myself that it was just because I had had a cold a few weeks earlier and that it was probably some weird post-nasal drip thing.  I had told myself that if it continued for more than two weeks or so, that I’d see my ENT doctor. It sounds gross, but I actually filmed it when it was happening just so I would be able to show it to my doctor because I didn’t want to have to do downward dog in a examination room to show him. But, the orange nose dripping thing went away within two weeks and never came back.  

So, again, I’m not sure if that was related, but I was just racking my brain trying to think of other random “symptoms” I might have been having these past few months.  I had also noticed in the past few months too that it seems like I’ve been losing more eyelashes than usual. But, that was just something I had chalked up to getting older, and perhaps a formula change in one of my eye makeups.  

Getting the Bloodwork Re-Checked

I went back in to have my platelets re-checked at my primary care doctor. Lo and behold, they were even lower this time, down to 28 from my count of 34 ten days earlier (again, platelets should be in the 140-400 range).  My doctor referred me to a hematologist, and I was able to get in for a same day appointment.  I’m writing this particular section in the hours before my appointment later this afternoon.

 

And wait, there’s more! 

The day after I had gotten the initial low platelet results, I started to have a fairly dramatic pain in my right side.  You might remember that I had a kidney stone back in 2013. This pain definitely felt “different” from that kidney stone, but it was still painful.  The pain, coupled with the alarming test results of the day before, led me to imagine horrific internal bleeding that was causing the pain. So, around midnight on a Friday night, Ken and I are driving to the ER.  They did a urinalysis and and a abdominal CT scan, and didn’t find a kidney stone. On the upside, the CT scan found that all my other abdominal organs were normal too. I had read that Thrombocytopenia can cause things like an enlarged spleen, or may also been seen with liver inflammation.  But, both the spleen and liver (and everything else) were all good. So, in a way, the CT scan and trip to the ER calmed my fears a bit. But, just a bit, not much.  The ultimate diagnosis was that I likely just had some muscular pain. 

 

Post Hematology Appointment

Okay, I’m back from my Hematology appointment. That is literally the longest I’ve ever sat face-to-face with a single physician in my entire life. We probably had a 40 minute discussion. She basically wanted to hear about any change or symptom that I have experienced, no matter how minor.  I told her about seeing an ophthalmologist back in 2016 for an ocular migraine (I thought I had blogged about this in a Friday Randomness post, but I guess not!).

I told her about seeing an optometrist last year for some sudden and dramatic dry eyes and some increased “halo” vision, especially at night. I told her about being in contact with my dad in the days prior to his diagnosis with a antibiotic-resistant bacteria called ESBL. I also told her about the other things I mentioned up top, like the painless bruises and the UTI. (Although those are fairly regular occurrences for me). I get one every few years it seems like), the weird nose drips, and the eyelashes falling out.

It’s funny, typing these things out here all make me sound or seem very “sickly.”  But in general, I feel fine. And, many of them I just contributed to the joys of getting older.  Obviously, for the symptoms I thought might have been concerning, like the dry eyes and other vision issues, I saw a doctor within a few weeks of its onset, and was given a treatment plan (warm compresses and large doses of fish oil) and the all-clear from the optometrist.  And, after my dad’s diagnosis with ESBL, I asked his doctor if I should be concerned about my contact with my dad, and the doctor said no. So that was good enough for me.

The hematologist also wanted to know all about my family history. I told her that my mom had a breast cancer diagnosis at 52, that my paternal grandfather died of colon cancer at 62, and that my dad has rheumatoid arthritis (an autoimmune disease).  

The hematologist said that since my platelet counts were quite low at 28, that she was starting me on a treatment — 40mg of dexamethasone, a oral corticosteroid, per day for four days.  Since the largest dose of dexamethasone available is 4mg, that means I’d have to take ten pills at a time. I’d have to come back on day three of the treatment for a another CBC (Complete Blood Count) blood test to see if the medication was improving my platelet counts.  

Then, the Hematologist did her own physical exam.  Listened to my chest and back with a stethoscope, pushed on my abdomen, examined my lymph nodes and examined my skin briefly.  

I asked her if there was anything I could do diet-wise to improve my platelet counts.  Like any particular foods I should avoid or increase. She said no, at least not until we have a better handle on the root cause of the platelet issue.  

The doctor ordered TWELVE VIALS of blood to be drawn.  Here were all the stickers printed that went on the individual vials of blood:

The hematologist went through general explanations of the types of tests she was ordering.

• Nutritional deficiency tests.  She said that sometimes low platelet counts could be caused by something as simple as a B12 vitamin deficiency or a folate deficiency, so she’d test for those.
• Inflammatory markers, which could be indicators for autoimmune diseases. She said autoimmune diseases can cause low platelets, and given my family history of Rheumatoid Arthritis, that it would be an important test.
• HIV.  She asked me if I had ever been tested for HIV, and I said no, so she was ordering a test for that.  (Although after I left the appointment, I realized I forgot to tell her that I used to donate blood fairly regularly, and I’m pretty sure I would’ve found out about that.)  I didn’t even bother to mention to her that I always used safe sex practices, because I figured people probably always say that and that she’d order the test anyway.
• Leukemia and other blood cancers. She prefaced this category of tests by saying, “There are some more serious things we will screen for.  Ordering these tests does not mean you should panic. I’m not panicking, you shouldn’t be panicking.” She explained that low platelets could be indicative of various types of leukemias.  She said that these blood tests would screen for various “markers” of leukemias, and if any of them came back as abnormal, she would then order a bone marrow biopsy. She then reiterated, “don’t panic.”

 

Next Steps

• The doctor instructed me to come back in 3 days for a simple complete blood count to see if the high-dose dexamethasone was improving my platelet count.  She said that if I came to the hematology office for the test, that I’d have the results back in a few minutes.
• The doctor said I should come back in one week for another 40 minute appointment, where she’d sit with me and discuss her interpretation of all the blood test results.  She said that if many of the inflammatory markers were abnormal, that I’d probably have to see a rheumatologist.
• She would release the test results to me via the office’s online portal.  She said that she only releases them after she personally has reviewed them.  She told me that she would call me if she found anything overly concerning or something that required more immediate attention.  Therefore, if I see something in the test results that was outside the normal range, that I should not panic because she did not deem it serious enough to warrant immediate attention.  

And now, I wait.  And be thankful for how amazing science and medicine is.  When we were on our way home from the hematology appointment, Ken said, “You know, it’s kind of amazing.  You’re only sick on paper.”

And that really stuck with me for some reason.  Here I am feeling fine. No fatigue or fevers or anything else that I would consider strikingly “wrong.”  The only reason I know something is wrong with me is because some results from a lab tell me that something is wrong.  And I think that’s pretty amazing. Because whatever it is, serious or not, that gives me enough time to start to beat this thing with a stick before it actually becomes symptomatic.  

Have you ever had scarily low platelet counts or other scary things in your bloodwork during a physical?  How did yours turn out?